Endovascular Repair vs Medical Therapy for Uncomplicated Acute Type B Dissection: Aortic Remodeling

Background: The optimal initial management for uncomplicated acute type B aortic dissection (uATBAD) remains unclear. We evaluated 1-year aortic remodeling and clinical outcomes of thoracic endovascular aortic repair (TEVAR) vs exclusively optimal medical therapy for uATBAD. Methods: Patients with uATBAD were retrospectively grouped by initial treatment modality, with 52 patients treated with TEVAR and 142 with optimal medical therapy. Clinical outcomes and aortic remodeling were compared at presentation and 1-year follow-up. Aortic remodeling parameters, including change in true lumen diameter, full lumen diameter, and true lumen index, and extent of false lumen thrombosis were assessed at 12 thoracoabdominal levels and compared between treatment groups. Results: TEVAR had lower 30-day/in-hospital mortality than optimal medical therapy (0% vs 11.3%; P < .01). Reintervention rates did not differ between groups (P > .05). Thirty-one TEVAR and 42 optimal medical therapy patients were included in remodeling analysis with a median follow-up of 6.9 months (interquartile range, 3.6-10.8 months). Change in true lumen diameter and true lumen index was greater in TEVAR than in optimal medical therapy from left subclavian artery to the diaphragm (P < .001). Change in full lumen diameter showed no difference between groups except at the superior mesenteric artery (P = .04). At the thoracic aortic levels, TEVAR showed significant shift toward full false lumen thrombosis (P < .001). Conclusions: TEVAR was associated with favorable aortic remodeling as well as short-term and midterm outcomes compared with optimal medical therapy in patients with uATBAD. The positive remodeling is more pronounced at thoracic aortic levels.